Accurate assessment of patient weight | Nursing Times 02/03/20, 6:22 PM

ASSESSMENT SKILLS

REVIEW
Accurate assessment of patient weight
14 MARCH, 2014

Recording accurate body weight is a fundamental part of patient assessment and

should be undertaken by trained staff using appropriate equipment

Abstract

Measuring patient weight is considered a routine assessment that is frequently

delegated to unregistered staff. Yet patient weight is a fundamental part of
nutrition assessment and may be used to calculate drug dosages and assess fluid
balance. It is vital that staff carrying out this measurement are trained and have
access to appropriate equipment that is regularly calibrated.

Citation: Evans L, Best C (2014) Accurate assessment of patient weight. Nursing

Times; 110: 12, 12-14.

Authors: Liz Evans is nutrition nurse specialist at Buckinghamshire Healthcare

Trust and chair of National Nurses Nutrition Group; Carolyn Best is nutrition nurse
specialist at Hampshire Hospitals Foundation Trust and secretary of the National
Nurses Nutrition Group.

This article has been double-blind peer reviewed

Scroll down to read the article or download a print-friendly PDF, including any tables and figures

Introduction

One in four patients admitted to hospital is already malnourished (Russell and Elia,
2010) so accurate assessment of nutritional needs is essential from admission
onwards to ensure the appropriate level of nutritional support is provided.

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There has been a lot of publicity on the importance of using nutrition screening tools
for patients entering a care setting, and developing and implementing an
appropriate individualised plan of care to ensure their nutritional needs are met.
Guidance on nutrition support for adults states that all hospital inpatients on
admission to hospital and all hospital outpatients on their first visit to a clinic
appointment should have a nutrition screening tool completed. It also recommends
that all people admitted to care homes be nutritionally screened on admission
(National Institute for Health and Care Excellence, 2006).

While anyone admitted to a clinical setting who is acutely unwell could be

considered to be at risk of undernutrition, certain groups pose a definite risk and
should be identified early. These include:

Patients with existing acute and long-term conditions such as chronic obstructive pulmonary disease;
Patients with long-term, progressive conditions such as dementia and cancer;
Patients who have been discharged from hospital recently;
Older people (Elia and Russell, 2009).

Recording an accurate body weight is a fundamental part of any nutrition screening

tool as well as other interventions that may arise as part of the patient’s treatment,
including accurate drug dosage (Clarkson, 2012) and fluid gain (oedema) or loss. An
accurate recording of body weight is also important when admitting patients for
whom specialist equipment, such as profiling beds for pressure relief, may be
needed.

NICE (2006) states that patients in hospital should have their body weight measured
weekly and when there is clinical concern. In the community, weight should be
assessed if it is relevant to the purpose of the visit, for example when patients are
receiving nutritional support or weight management reviews.

Problems with weighing patients

Inconsistencies in recording patient body weight, as well as using inaccurate or

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inappropriate weighing equipment, can have a negative impact on patient care

(Clarkson, 2012). This can increase the risk of errors in diagnosis, interventions,
treatment or medication dosage (Department of Health, 2010; Local Authorities
Coordinators of Regulatory Services (LACORS), 2009).

Lees and Allen-Mills (2009) undertook a small study of nurses involved in weighing
patients in an acute medical admissions unit. They suggested weighing patients
used to be an integral part of the routine nursing admission assessment but
increasing demands on qualified nurses has resulted in delegation to non-registered
health professionals. They found some nurses do not attach the same importance to
it as other routine assessments and many working on the unit were reluctant to
weigh patients. One of the reasons quoted was they felt “uncomfortable”
suggesting that patients should be weighed and that, without a good reason,
recording a body weight could be perceived as unnecessarily invasive.

When the nurses were asked to explain why it was necessary to weigh patients,the
main reason cited was the patient was on medication. Little importance was
attached to weighing patients who were frail, underweight or obese to assess their
nutritional needs. These results may be due to the specialty where the study was
conducted and may have differed if nurses from an elderly care ward, for example,
had been included (Lees and Allen-Mills, 2009).

The conclusions of Lees and Allen-Mills’ (2009) study appear to be supported by the
results of a nationwide nutrition survey carried out in 2011, which highlighted large
variations in nutrition screening policies and practices between healthcare settings
(Russell and Elia, 2010). The survey identified that less than half of patients were
cared for in hospitals where weighing was carried out in all wards - even though
most hospitals stated they had a nutrition screening policy.

It also suggested that, in many centres, weighing scales were not calibrated properly

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- indeed, some had not been recalibrated for over a year. An audit of a number of
NHS organisations found that weighing equipment in regular use in clinical areas
was often incorrectly calibrated or of the wrong type (LACORS, 2008). All weighing
scales should be calibrated on an annual basis (LACORS, 2009), but some centres
were not aware this was a national recommendation (LACORS, 2008).

Repeating the audit in 2009, LACORS found a third of all hospital scales tested by
council trading standards officers were found to be inaccurate; it also revealed that
many hospital staff were not correctly trained to use the weighing equipment
(LACORS, 2009).

As a result of these findings, a number of recommendations were made to hospitals

(Box 1) and guidance was offered on what to look out for to ensure the correct use
and maintenance of weighing apparatus (Box 2). In the following years, the DH
(2010) issued an alert advising hospitals to review the report by LACORS and draw up
an action plan if their weighing equipment did not meet the recommendations.

Box 1. Kep points of the LACORS recommendations

Each hospital or trust should procure all weighing equipment centrally (rather than on a ward-by-ward basis), ideally by the department
responsible for maintaining the equipment
Each trust should instigate a programme of testing for their equipment
Basic training in the use of weighing equipment should be given to all staff who use it
Any inaccurate equipment should be removed from service for replacement or repair
All scales that are used for medical applications should be Class III or higher
All scales that are used for medical applications should only display weights in metric units

Source: Local Authorities Coordinators of Regulatory Services (2008)

Box 2. Learning points

Who is responsible for calibrating the scales in your clinical area?

Is it done yearly as recommended?
Does your organisation have the correct class scales?

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Is there a mechanism in place for ensuring that all staff who weigh patients have had appropriate training?

Source: Local Authorities Coordinators of Regulatory Services (2009)

Accuracy of weighing equipment

Medical weighing equipment is covered in Schedule 3 of the Non Automatic

Weighing Instrument Regulations (LACORS, 2008). In healthcare premises it is a
legal requirement to have weighing equipment that is accurate and fit for purpose.

Weighing scales in hospital must be in the Class III category because small changes
in weight may be clinically relevant; in GP surgeries, nursing or residential
accommodation or in the patient’s own home, Class IIII category weighing scales are
acceptable (DH, 2010; UK Weighing Federation, 2002). To clarify this grading, Class I
scales provide the highest degree of accuracy, and Class IIII, the lowest. Class IIII
scales include bathroom scales aimed at domestic use and should not be used in the
hospital environment.

Key points for practice

Organisations should ensure they take note of the recommendations outlined in

Boxes 1 and 2. Guidance for individual practitioners on how to weigh a patient is
detailed in Box 3.

Box 3. Weighing a patient

Ensure the scales are balanced, or display zero before weighing the patient
When weighing a baby, if a protective covering is placed in the weigh pan ensure this is allowed for by pressing the appropriate ‘tare’ or
‘zero’ key
Ensure that no part of the weigh platform or load receptor is touching a fixed object, such as a wall
Ensure the patient’s clothing is not touching any fixed part of the scales or surroundings
When using chair scales, ensure the patient’s feet are not touching the ground and that their arms are not brushing against an adjacent
fixture
When monitoring periodical weight change ensure the patient always wears clothing of similar weight
Do not weigh young children on scales of high capacity designed for adults. The weighing interval may be too coarse, resulting in a higher-
than-acceptable percentage error

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Source: UK Weighing Federation (2002)

Alternatives to weighing patients

It is not always possible to obtain an accurate body weight for all patients on
admission to hospital. Patient acuity may demand that in some circumstances
alternative measures of recording a body weight must beconsidered. In such cases,
practitioners should:

Ask the patient about their latest recorded weight;

Check their medical records;
Ask their relatives for their last recorded weight;
Undertake a visual assessment - does the patient “look” thin? For example, are rings obviously loose on fingers;
Use a weighing bed.

These may not give an accurate body weight but may provide the healthcare team
with some guidance to be able to plan the level of intervention required for the
patient until an accurate weight can be recorded.

Conclusion

Recording and documenting an accurate patient body weight is a fundamental part

of any nutrition screening tool and is a valuable tool in monitoring fluid balance and
calculating medication doses. Nurses are key in ensuring an accurate assessment of
body weight and patient risk and in ongoing monitoring and intervention of
appropriate nutritional care. Weight should not be considered as a one-off
observation on admission but must be recognised as an important tool for ongoing
assessment throughout the patient’s health journey and should be carried out by
staff who have the appropriate knowledge and training.

Key points

Recording accurate body weight is a fundamental part of nutrition screening

Measuring body weight is vital for accurate prescribing of some drugs and monitoring of fluid balance
Weighing scales in hospital must be Class III category
Scales should be calibrated every year
Staff should be trained so they know how to use weighing equipment properly

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Clarkson DM (2012) Patient weighing: standardisation and measurement. Nursing Standard; 26: 29, 33-37.
Department of Health (2010) Estates and Facilities Alert Ref: EFA/2010/001. Medical Patient Weighing Scales. London: DH.
Elia M, Russell C (2009) Combating Malnutrition: Recommendations for Action. Redditch: British Association of Parenteral and Enteral
Nutrition.
Local Authorities Coordinators of Regulatory Services (2009) The Weight of the Matter: Final Report of the LACORS National Medical
Weighing Project 2008/9. London: LACORS.
Local Authorities Coordinators of Regulatory Services (2008) The Weight of the Matter: Interim Report of the LACORS National Medical
Weighing Project 2008/9. London: LACORS.
Lees, L, Allen-Mills G (2009) Auditing the nursing standard for weighing patients on an acute medical unit. Nursing Times; 105: 27, 12-13.
National Institute for Health and Care Excellence (2006) Nutrition Support in Adults: Oral Nutrition Support, Enteral Tube Feeding and
Parenteral Nutrition. London: NICE.
Russell C, Elia M (2010) Nutrition Screening Survey in the UK and Republic of Ireland in 2011.
UK Weighing Federation (2002) Guidance Notes Relating to the Legal Prescription of Medical Weighing Scales. UK Weighing Federation.
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